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Editor’s Note: For more than two decades, Tali Seumanutafa, battled a recurring bone infection, first in her native Samoa, and then in Hawaii and California. During her entire period in the United States, she was undocumented and uninsured.

OAKLAND, Calif. – Tali Seumanutafa’s battle against osteomyelitis, a bacterial bone infection, began in her native Samoa at age two, took her to Hawaii for almost a year and has kept her in California for over two decades.

During that time, Seumanutafa, now 26 and a student at City College of San Francisco, underwent 25 surgeries, which included a number of bone and skin grafts and extended hospital stays, one as long as a year-and-a-half. During this entire period, she has been undocumented and uninsured.

A couple of weeks ago, the newly minted DACA (Deferred Action for Childhood Arrivals) beneficiary took advantage of the deferred action status she got early this year and enrolled in Medi-Cal, California’s Medicaid program for low-income people. She is likely to get her Medi-Cal card by the end of this month.

“It’s such a weight off my mind,” Seumanutafa said, as she walked out of the Alameda County Health Care Services office, where a health information technician had spent almost an hour with her, helping her fill out the lengthy Medi-Cal application form.

California is one of two states – the other being New York -- that offers comprehensive Medi-Cal coverage for young immigrants in the deferred action program, provided they meet the other eligibility criteria. According to a report by University of California researchers, as many as 125,000 low-income immigrants statewide could qualify under the state’s Medi-Cal program.

But many of them are expected to remain uninsured because they are not aware of their eligibility, have trouble enrolling or worry about the impact it could have on relatives living in the United States illegally.

Seumanutafa, who became a DACA beneficiary back in January, said she didn’t know she was eligible until a reporter told her a couple of weeks ago. She said she tried to enroll online on her own but gave up half way because navigating the system was too complicated.

Prolonged medical treatment

Seumanutafa came with her mother to California from Hawaii in 1992 on a tourist visa, after Shriner’s Hospital for Children in Honolulu, Hawaii, which the hospital in Samoa recommended she go to, discharged the toddler.

But within weeks after her arrival in San Francisco, Seumanutafa’s left leg began swelling up again, causing her pain. Her mother, Elisepta, feared the infection had returned. Doctors at Shriner’s in the city confirmed that was indeed the case.

Over the next decade, their tourist visas long expired, the pair stayed on in San Francisco, with Seumanutafa going in and out of Shriner’s, while her mother worked as a caregiver in people’s homes.

Seumanutafa received free treatment at Shriner’s. When she aged out of the facility at age 18, doctors told her she was infection-free, but that she must get periodic check ups at some other facility because osteomyelitis sometimes recurs.

She enrolled in Healthy San Francisco (HSF), a program designed to make health care services available and affordable to uninsured San Francisco residents, regardless of their immigration status. Enrollees are assigned a health care facility in the city. To remain on the program though, residents need to renew each year.

Two years after her discharge from Shriner’s, her osteomyelitis recurred, and Seumanutafa checked into San Francisco General Hospital (SFGH). Unbeknownst to her and her mother, her Healthy San Francisco membership had expired.

It is not clear whether Seumanutafa would have benefitted being in the program though, given the number of surgeries she needed. A HSF spokeswoman, who would only identify herself as Helen, said “coverage is decided on a case by case basis,” and that “some surgical procedures are covered,” but she wouldn’t say whether surgery for osteomyelitis was among them.

In 2013, after a two-year-long treatment, doctors at SFGH gave her a clean bill of health but told her she must return for periodic checkups. The hospital also sent the undocumented woman a bill for about $500,000.

“I have no idea how I am going to deal with that,” she said, noting that since the hospital hasn’t tried to force her to pay up until now, she’s going to let well enough alone.

Seumanutafa, who moved to Oakland recently, has set her heart on becoming a registered nurse. Her personal experience, as well as her part time City College job with Voices of Immigrants Demonstrating Achievement, have underscored how important having ready access to health care is for immigrants like herself.

One of the first things she plans to do when she gets her Medi-Cal card is to go back to San Francisco General to make sure the bone growth in her left leg “is where it should be.”

She is also planning to see a dentist. A dental checkup some time ago indicated she had more than a dozen cavities.

“I don’t want to lose all my teeth by the time I am 32,” she said, noting: “I’ve lost two already.”